One of the most damaging effects of psychiatric illness is the experience of stigma. Stigmatization is the social rejection of those with mental illness. This may be seen in the tendency to ridicule or shun those with mental illness. It is seen in employment discrimination and in the derogatory language that is pervasive among many in society.

“Stigma” is a Greek word that once referred to the bodily signs that were used to show that there was something morally wrong with the person so marked. These signs were made by cuts or burns and indicated that the person was a slave, a criminal or a traitor…..a blemished person to be avoided. The numbers tattooed on the arms of concentration camp inmates by the Nazis and the yellow stars Jews were forced to wear are examples from more recent history.

Stigmatization induces feelings of anxiety, insecurity, shame and even self-hatred. Self-hatred is the result of internalizing the attitudes of others. Every new situation every new encounter brings with it the anxiety of not knowing whether one will be accepted, rejected or shamed.

Stigmatization is reinforced by distorted representations of individuals with mental illness in the media. Newspaper accounts are often sensationalist. Many false stereotypes appear in movies and television shows which often demean or mock those with mental illness.

This stigmatization is often extended to families, counselors and psychiatrists. The stigma associated with mental illness is so widespread that we have trouble agreeing on terminology to describe it. We use multiple euphemisms. What is the most reliable term to describe the distress and impact experienced by individuals with mental illness? Mental health issues, mental illness, psychiatric disorder, psychiatric illness?

In an attempt to reduce stigma many prefer the vaguer and more dilute term “mental health issues”. The problem with this term is that it trivializes the problem and does not convey the seriousness and enormity of some of these conditions.  Could you imagine a surgeon telling a patient with a fractured spine that he has “back issues”.
The basis for stigma is fear.
This fear is the fear of difference, the fear of contagion, the fear of vulnerability.

Fear of differences exists in all societies and shows itself in many forms such as racism, anti-Semitism, homophobia etc. Fear of strangers is an evolutionary survival mechanism. It is the fundamental component of attachment behavior where the newborn infant instinctively attaches to its mother. This is to protect the infant from hostile predators and strangers. For many people this basic process may go wrong and they grow up lacking a sense of secure attachment. They experience heightened levels of anxiety and fear when they encounter something that is strange or different. This makes them prone to display prejudice and discrimination. They are  threatened by people who are in some way different from themselves. People who are more securely attached are much more receptive and open to others and able to establish more varied relationships.

Stigma also derives from the fear of “contagion”. The fear of contagion is the fear of catching a disease, particularly if the disease is incurable. One of the greatest historical examples of this was leprosy. Those with leprosy were cast out and isolated from society. There were similar attitudes towards those with AIDS. This has lessened as the treatment for AIDS has become so successful.

The fear of contagion is unconsciously and irrationally extended to psychiatric illness and leads to ostracization and isolation of those with the illness. This is based on the defensive reasoning of “out of sight, out of mind”. What this attitude amounts to is really a denial that we are all vulnerable to illness of one kind or another and that this is part of the human condition that unites us rather than separates us.

The act of stigmatizing gives the individual a false sense of superiority or immunity. It is seen in openly hostile attitudes, derogatory humor, avoidance and ridicule.

Stigma involves regarding the person as an illness rather than as a human being with multiple roles and characteristics.

Blaming the individual with the illness for having the illness is the way that people attempt to delude themselves that they are immune.

The truth is that mental illness is no different in any way from physical illness. Mental illness has nothing to do with intelligence, character or moral integrity. It does not result because of our failings of deficiencies; it is not a punishment for our sins. Anyone, repeat anyone can become mentally ill, including your mother or father, bather or sister, husband or wife, son or daughter, and yes, you and me.

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